A lung cancer diagnosis can bring uncertainty, but advances in diagnosis and minimally invasive surgery provide more treatment options than ever before. At the Institute for Thoracic Surgery in Miami, Florida, Mark Dylewski, MD, and the medical team provide comprehensive evaluation and surgical care for lung cancer. Dr. Dylewski specializes in advanced, minimally invasive techniques designed to treat cancer while preserving as much healthy lung tissue as possible. Call the office or book an appointment online today to discuss your treatment options.

What is lung cancer?

Lung cancer develops when abnormal cells in the lungs grow uncontrollably and form a tumor. The two primary types are non-small cell lung cancer (NSCLC), which accounts for most cases, and small cell lung cancer (SCLC).

Smoking is the leading risk factor for lung cancer, but the disease can also occur in people who have never smoked. Other potential risk factors include secondhand smoke, radon exposure, certain occupational exposures, and a family history of lung cancer.

Early diagnosis is important because lung cancer may be easier to treat before it spreads to other areas of the body.

What are the symptoms of lung cancer?

Lung cancer doesn’t always cause noticeable symptoms in its early stages. When symptoms do develop, they may include:

• A persistent or worsening cough
• Coughing up blood
• Shortness of breath
• Chest pain
• Hoarseness
• Recurrent respiratory infections
• Unexplained weight loss
• Persistent fatigue

These symptoms can occur with many conditions other than cancer. If you develop persistent respiratory symptoms or imaging identifies a suspicious lung nodule or mass, Dr. Dylewski can perform a thorough evaluation and recommend appropriate next steps.

How is lung cancer diagnosed?

Diagnosing lung cancer typically involves imaging studies, such as a chest CT scan, to evaluate suspicious areas within the lungs. Additional testing may include PET imaging or a biopsy to collect tissue and determine whether cancer cells are present.

If lung cancer is confirmed, Dr. Dylewski evaluates the cancer’s type, size, location, and stage to determine whether surgery is an appropriate treatment option.

How is lung cancer treated?

Treatment depends on the type and stage of lung cancer, as well as your overall health and lung function. Surgery may be recommended for certain early-stage cancers that haven’t spread beyond the lung.

When appropriate, Dr. Dylewski uses minimally invasive and robotic-assisted techniques to remove cancerous tissue through small incisions. Depending on the tumor, surgery may involve removing a small portion of lung tissue, a lung segment, or an entire lobe. Here at The Institute for Thoracic Surgery, our surgeons are trained in the latest lung-sparing surgical techniques. In the appropriate clinical setting, our surgerons strive to utilized advanced techniques such a segmental resection, and/or sleeve resections to spare health lung from being removed unnecessarily all while balancing curability and long-term survival for the individual patients disease process. 

Minimally invasive surgery can offer benefits such as less postoperative pain, smaller scars, and a faster recovery compared with traditional open surgery. Some patients may also need chemotherapy, radiation therapy, targeted therapy, or immunotherapy as part of their overall cancer care.

Lung Cancer in People Who Have Never Smoked

When someone is diagnosed with lung cancer, one of the first questions often asked is whether they have a history of smoking. Although tobacco exposure remains the leading risk factor for lung cancer, smoking is not the only cause. An important and growing population of patients develops lung cancer despite having never smoked.

Lung Cancer in Never-Smokers

Research cited by the National Institutes of Health estimates that approximately 10–15% of lung cancers occur in people who have never smoked. Studies have also reported a somewhat higher incidence among women who have never smoked compared with men who have never smoked, although researchers caution against interpreting this difference as evidence that women who have never smoked are inherently at greater risk.

In clinical practice, an increasing number of never-smoking patients—particularly women between the ages of 50 and 70—are being diagnosed with lung adenocarcinoma.

“We are seeing an increased number of women, ages 50–70, who have never smoked being diagnosed with adenocarcinoma,” said Mark Dylewski, M.D., a thoracic surgical oncologist and a leader in robotic thoracic surgery. “However, we still do not have a clear understanding of why this is occurring. To date, research has not identified a single factor that explains these cases.”

Potential Risk Factors

The reasons some people who have never smoked develop lung cancer remain incompletely understood. Potential risk factors may include exposure to secondhand smoke, environmental or occupational toxins, inherited or acquired genetic abnormalities, certain viral infections, a family history of lung cancer, and prior exposure to radiation therapy.

For some patients, molecular alterations within the tumor itself may provide important information about why the cancer developed and how it can best be treated. Advances in molecular and genomic testing have increasingly allowed physicians to identify specific genetic alterations that may influence treatment decisions, particularly in patients with non-small cell lung cancer.

It is important to recognize that lung cancer in never-smokers is not a single disease. Adenocarcinoma is the most common histologic subtype in this population, but other forms of lung cancer can also occur.

The Importance of Early Detection

Early detection remains one of the most important factors in the successful treatment of lung cancer. Unfortunately, lung cancer may produce few or no symptoms during its earliest stages.

Current lung cancer screening recommendations are primarily directed toward individuals with significant cigarette-smoking histories because the benefits of screening must be weighed against potential harms, including false-positive findings, additional imaging, and invasive diagnostic procedures. As a result, individuals who have never smoked generally do not meet current criteria for routine population-based lung cancer screening.

Consequently, lung cancer in never-smokers is sometimes discovered incidentally when imaging is performed for another medical reason. A chest X-ray or CT scan obtained during an evaluation for an unrelated condition may reveal a suspicious pulmonary nodule or mass in someone who would not otherwise be considered at high risk for lung cancer.

This makes clinical awareness particularly important. A patient's lack of smoking history should not eliminate lung cancer from the differential diagnosis when an abnormality is identified on chest imaging.

Treatment of Lung Cancer in Never-Smokers

When lung cancer is identified at an early stage, potentially curative treatment may be possible. For appropriately selected patients with localized disease, surgical resection remains an important component of treatment.

Modern minimally invasive and robotic-assisted thoracic surgery have expanded the ability of experienced thoracic surgeons to perform anatomically complex lung resections through smaller incisions. When appropriate, these approaches may offer patients the benefits of less invasive surgery while maintaining the principles of sound oncologic resection.

For patients with advanced disease, treatment may involve a combination of surgery, systemic therapy, radiation therapy, immunotherapy, and targeted therapy. Molecular profiling of the tumor can be particularly important in never-smokers with adenocarcinoma because certain actionable genetic alterations occur more frequently in this population. Identification of these alterations can help guide the selection of targeted therapies.

The treatment of lung cancer is therefore increasingly individualized, based not only on the stage and location of the tumor, but also on its molecular characteristics and the patient's overall health and treatment goals.

Awareness Matters

Although smoking remains the most significant preventable risk factor for lung cancer, a history of smoking is not a prerequisite for developing the disease. Patients who have never smoked can and do develop lung cancer, and clinicians should remain attentive to suspicious symptoms or abnormal imaging findings regardless of smoking history.

“We need to better understand why lung cancer develops in people who have never smoked,” Dr. Dylewski said. “In the meantime, it is important that we recognize that lung cancer can occur in this population and that a lack of smoking history should not lead to a delayed diagnosis.”

Greater awareness among both patients and physicians, combined with advances in imaging, molecular diagnostics, systemic therapies, and minimally invasive surgery, offers an increasing number of patients the opportunity for earlier diagnosis and more individualized treatment.

Key Takeaway

Lung cancer is not exclusively a disease of smokers. Approximately 10–15% of lung cancers occur in people who have never smoked. Although routine screening is not currently recommended for the general never-smoking population, new or persistent abnormalities on chest imaging should be evaluated appropriately. When lung cancer is detected early, multidisciplinary treatment—including surgery, targeted therapy, immunotherapy, and radiation when appropriate—can offer patients meaningful opportunities for long-term disease control and, in selected cases, cure.

Lung cancer can occur in people who have never smoked. While the causes are not always known, increasing awareness, appropriate evaluation of suspicious findings, molecular testing, and advances in multidisciplinary treatment are improving our ability to diagnose and treat these patients.

To learn more about lung cancer diagnosis and surgical treatment, call the Institute for Thoracic Surgery or schedule a consultation online today.